Beyond kegels: pelvic physical therapy

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Maybe you’ve gone to physical therapy to help you recover from an injury or car accident or simply to reduce pain. Perhaps you overheard a friend say that she was heading to “PT” (short for physical therapy) after work.

If you’re newer to the concept, physical therapists are health care professionals who help patients reduce pain and improve or restore physical mobility. They examine each individual and develop a plan, using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Back pain, sports injuries, arthritis, and sciatica are all conditions we often associate with physical therapy. But as it turns out, your pelvis can benefit from physical therapy too.

Pelvic physical therapy is a specialization within the larger field of physical therapy. We spoke with Annemarie Lepe, a board-certified women’s health clinical specialist, pelvic physical therapist, and clinic director of Miracle Physical Therapy, to learn more about this under-the-radar but highly beneficial area of physical therapy.

What is pelvic physical therapy?
“Pelvic physical therapists have specialized training in internal and external evaluation and treatment of pelvic floor dysfunction as it relates to sexual, bowel, and bladder function,” says Lepe. “With this training, pelvic physical therapists specialize in different areas of practice, like pregnancy and postpartum, pelvic pain, sports and performance, men’s health, and even pediatrics.”

Lepe believes this makes anyone who’s experiencing sexual, bowel, or bladder dysfunction a natural candidate for pelvic physical therapy. She also sees patients with muscle imbalances that encompass the pelvic floor, like runners with ongoing hip pain. “Anyone with a pelvic floor — so, pretty much everyone — might benefit from pelvic pelvic physical therapy at some point in their life,” she says.

What are the benefits of pelvic physical therapy?
While there are many benefits to seeing a pelvic physical therapist, like treating painful sex and vaginal exams or stopping urinary leaking, Lepe emphasizes the following three advantages:

Specialized treatment and trained experts
“Many think that gynecologists or urologists are the only providers with answers about pelvic issues, but they have vastly different training than pelvic physical therapists,” explains Lepe. “Because of this, they don’t treat neuromuscular or musculoskeletal issues effectively. Just like I don’t deliver babies or prescribe medication, a gynecologist isn’t skilled in evaluating musculoskeletal dysfunction or performing manual therapy, therapeutic exercise, and the other modalities that pelvic physical therapists use.”

Understand and resolve the underlying issues
“Many postpartum women are told their issues will resolve when they start exercising, but this often doesn’t happen,” Lepe says. “Generalized exercise won’t fix the underlying pelvic floor dysfunction, but pelvic physical therapy and tailored exercise plans from an expert can.”

More time, education, and care
“For many of my patients, the most groundbreaking part of treatment is actually having someone sit down and explain what’s happening, outline the treatment program, and follow up consistently,” Lepe explains. “It’s a luxury that most healthcare providers no longer have, and I’m grateful to be part of a profession that puts such emphasis on this component.”

Why didn’t I know about pelvic physical therapy before?
All we seem to hear about these days are “kegels, kegels, kegels.” While kegels are one way to increase pelvic floor strength, they definitely aren’t the only way treat pelvic floor dysfunction.

Lepe hypothesizes that pelvic floor physical therapy isn’t as well known because many don’t view the pelvic floor in the same way as they do the neck or back. “I express to patients that I’m basically an orthopedic physical therapist who is skilled in pelvic exams to evaluate muscles, and I’m applying the same thought process that I would if I were treating their knee or shoulder,” she says. “But the fact that vaginas and rectums are involved makes everyone — patients and other healthcare providers included — think that there’s a different set of rules at play.”

What to expect during your first appointment
During a patient’s first session with Lepe, half the time is spent in conversation and the other half is spent evaluating and treating. “First, I’ll ask about the person’s complaints and ultimate goals and then get a verbal symptom and medical history,” she says.

Based on this information, Lepe is able to have a conversation with a patient about how the pelvic floor works as it relates to their specific issues and discuss what their home program will look like. Then, if the person is comfortable, she performs an external and potentially an internal vaginal or rectal exam. “I do this to figure out what muscles are functioning, what the person’s control and coordination is, and what replicates the symptoms we need to address,” she explains. “If someone needs to practice muscle coordination — whether contracting or relaxing — we spend time on this. I’ll also perform manual therapy if the person needs this to address trigger points and muscle overactivity.”

To wrap up the session, Lepe reviews a summary of her findings with the patient, answers their questions, and assigns a home program. Depending on a patient’s issue, she’ll see them anywhere from twice a week to once a month.

“I think people assume that pelvic physical therapy is awkward and avoid coming in because they’re worried about what’s going to happen,” she says. “The most common thing I hear after a visit is that it wasn’t as weird as the person expected, especially because they see progress and feel like they finally understand their symptoms. Plus, since I don’t use a speculum or stirrups, it’s much more comfortable than a pap smear!”

English Taylor is a San Francisco-based women’s health and wellness writer and birth doula. Her work has been featured in The Atlantic, Healthline, Refinery29, NYLON, and Modern Fertility. Follow English and her work at https://medium.com/@englishtaylor or on Instagram at @englishtaylor.